Provider Demographics
NPI:1720372493
Name:ROBERTSON, SUE ANN (MSN, APRN, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MSN, APRN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030A BURLEW BLVD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1735
Mailing Address - Country:US
Mailing Address - Phone:270-926-2273
Mailing Address - Fax:270-684-3212
Practice Address - Street 1:1030 BURLEW BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1735
Practice Address - Country:US
Practice Address - Phone:270-926-2273
Practice Address - Fax:270-684-3212
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006902363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner